Migraine Headaches

Migraines don’t have a single clear cause, but doctors believe they result from abnormal brain activity that affects nerve signaling, blood vessels, and brain chemicals. This activity can temporarily change how the brain processes pain and sensory information.

Causes (What’s Happening in the Brain)

• Nerve signaling changes: Overactive nerve cells may release chemicals like serotonin and calcitonin gene-related peptide (CGRP), which cause blood vessels in the brain to widen and trigger inflammation and pain.

• Brainstem involvement: The brainstem and its interaction with the trigeminal nerve (a major pain pathway) appear to play a central role.

• Genetics: Migraines often run in families, suggesting an inherited sensitivity to triggers.

Risk Factors (Who Is More Likely to Get Migraines)

1. Genetics – If one or both parents have migraines, your chances increase significantly.

2. Age – Migraines often begin in adolescence or young adulthood, but they can occur at any age.

3. Sex – Women are 2–3 times more likely than men to have migraines, partly due to hormonal influences (estrogen).

4. Hormonal changes – Fluctuations in estrogen (menstrual cycle, pregnancy, menopause, or birth control use) can trigger migraines.

5. Lifestyle and environment:

   • Stress or emotional changes

   • Skipped meals or fasting

   • Lack of sleep or oversleeping

   • Caffeine overuse or withdrawal

   • Alcohol (especially red wine)

   • Certain foods (aged cheeses, processed meats, artificial sweeteners)

6. Sensory triggers – Bright lights, loud sounds, strong odors.

7. Weather changes – Barometric pressure shifts, extreme heat, or storms.

8. Medical conditions – Depression, anxiety, epilepsy, sleep disorders, and high blood pressure can all be associated with a higher risk.

Migraines can cause more than just head pain—they often involve a wide range of symptoms that can disrupt daily life. Symptoms can vary from person to person, and even from one migraine attack to another.

Main Migraine Symptoms

• Headache pain: Moderate to severe, throbbing or pulsating, usually on one side (but sometimes both).

• Duration: Can last from a few hours up to 3 days if untreated.

• Pain worsens with activity: Physical activity, bending, or climbing stairs often makes the pain worse.

Other Common Symptoms

• Nausea and vomiting

• Sensitivity to light (photophobia)

• Sensitivity to sound (phonophobia)

• Sometimes sensitivity to smell or touch

• Blurred vision or vision changes

Symptoms of Aura (in about 1 in 3 people)

These occur before or during the headache phase and last 20–60 minutes:

• Flashing lights, zigzag lines, or blind spots in vision

• Tingling or numbness in the face, arms, or hands

• Trouble speaking or finding words

• Muscle weakness on one side (rare, in hemiplegic migraine)

Diagnosing a migraine is mostly based on a person’s medical history, symptoms, and a physical exam. There’s no single blood test or scan that confirms migraines, but doctors use established criteria to tell them apart from other types of headaches.

How Migraines Are Diagnosed

1. Medical history

   • Detailed discussion of headache frequency, duration, and characteristics (e.g., one-sided, throbbing, worsened by activity).

   • Review of other symptoms like nausea, aura, or sensitivity to light/sound.

   • Family history of migraines (since they often run in families).

2. Headache diary

   • Patients are sometimes asked to track when headaches occur, how long they last, what symptoms accompany them, and possible triggers.

3. Physical and neurological exam

   • Checking reflexes, coordination, balance, vision, and sensation to rule out other neurological conditions.

4. Diagnostic criteria (International Classification of Headache Disorders – ICHD-3)
   A migraine is diagnosed when the patient has had at least 5 attacks that meet these features:

   • Headaches lasting 4–72 hours (untreated or unsuccessfully treated)

   • Headache with at least two of these:

     • One-sided location

     • Pulsating quality

     • Moderate or severe pain intensity

     • Worsening with routine activity

   • During the headache, at least one of these:

     • Nausea and/or vomiting

     • Sensitivity to light and sound

5. Tests (if needed)

   • Usually not required if the pattern clearly matches migraines.

   • MRI or CT scan may be ordered if headaches are new, severe, or have unusual features to rule out tumors, stroke, aneurysms, or other conditions.

   • Blood tests may be used to check for infections, thyroid problems, or other causes if symptoms don’t fit the typical migraine picture.